Individual
ALFONSO CRUZ MANUEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7653 COLDWATER CANYON CT, NORTH HOLLYWOOD, CA 91605-2048
(818) 200-7062
Mailing address
7653 COLDWATER CANYON CT, NORTH HOLLYWOOD, CA 91605-2048
(818) 200-7062
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95005711
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95005711
NP FURNISHING NUMBER
CA
Enumeration date
12/25/2016
Last updated
05/07/2024
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